Mitchell retires but will stay until new CEO is on board
MedRec archival system set for April launch; complements LastWord physician order entry
Dermatology expands outpatient services for skin cancer, aesthetics and rejuvenation services
Books on the desktop: e-Books available through Health Library
Plastic surgery resident Kim dies in Tahoe ski accident
Energy to Medicine
by: Lawrence M. SHUER
The recent news about the energy crisis may have an unintended yet familiar ring to health providers because the economic issues facing the California power industry are strikingly similar to what we face in the medical business environment.
The power industry is in dire financial straits at least in major part because utilities are paying escalating costs for power while the prices they charge consumers are capped by the state.
Medical facilities and providers here in the Bay Area have also seen business costs skyrocket because of increased costs not only of energy but of housing, labor and supplies as well. New technological advances are ubiquitous, and as an academic medical center we are obliged to provide "cutting-edge" or at least state-of-the art care. New equipment is expensive and usually requires a large capital outlay.
Like the private utility companies, academic medical centers do not have the flexibility to recoup rising costs because the charges to consumers are capped by binding contracts with private health insurance companies. And the government continually ratchets down Medicare payments, which keep reimbursements far below the actual costs of delivering care.
Stanford Hospital is facing financial pressures, and we should all be troubled at how a hospital full of patients can nevertheless hemorrhage money. This is similar to the child who takes lemonade from the family refrigerator to sell to passersby for a penny, only to wonder why his family isn't thrilled with his or her business acumen.
In December we witnessed the stand-down between Sutter Health (Palo Alto Medical Foundation) and Blue Cross over HMO contract rates. Eventually, Sutter signed a contract with Blue Cross but not until many of its California Care HMO patients were drawn into the fray and told that they had to change physicians or pay more to see their usual doctors at Palo Alto Clinic and other Sutter facilities.
What can we do? Not much alone, but as the Sutter/Blue Cross standoff illustrates, we need support. It's worth noting that the Sutter/Blue Cross contract was signed after many of PAMC's California Care patients protested or even switched insurance companies to stay with their doctors.
The standoff and support of Palo Alto Clinic by patients tells me that it is time for us to educate our patients and convince government officials that the current medical economic environment is destroying what until recently has been the worldwide model for quality medical care.
Hospitals and doctors need to economize and see incomes as something less than an unlimited birthright. But the public and our government bear an equal or greater share of responsibility to contribute their fair share to the costs. More specifically, government officials must listen to their constituents' needs and desires and respond with favorable legislation. In some cases, the response may well mean spending more money to support health care.
I predict that we will see major hospitals go bankrupt if nothing is done to change the present situation. Will hospitals face their own version of a rolling blackout with rolling closures of emergency rooms to conserve resources? Could neighboring hospitals can handle our overflow of trauma or complex care patients? I don't believe so. We must take an active role in spreading the word about the dangerous trajectory medicine is taking.
Certainly we can learn from the power industry, which failed to adequately warn the public of impending shortfalls in electricity. The shortfalls weren't caused by the utilities, but these organizations are now being blamed for the power gap because they are the source of electricity. Are we to be blamed because we are the source of health care? I don't want to stand by passively to find out if we are to be scapegoats - individually and collectively.
Certainly interesting times are ahead. I predict that Stanford will have to follow the lead of Palo Alto Clinic and simply walk away from contract negotiations when terms are no longer viable. At that point, we must be sure that our patients are allies in our discussions.
Recently one organization that has successfully lowered health care costs for businesses in the Bay Area admitted it may have pushed too hard and gone too far. The organization realized its success at lowering costs may be contributing to the demise of quality health care in this area. That's a message we must communicate in order to provide a little preventive medicine for health care in our region.
* * *
Finally, I'd like to address a truly sad topic, whicht affects us all in some measure. On Feb.10 Edward Kim, one of our plastic surgery residents, tragically lost his life in a skiing accident in the Lake Tahoe region. (See related story.) Ed was a healthy, bright and gregarious young man. Our thoughts go to his wife, Heather; his parents and his entire family. His passing has touched many of us who knew him and worked with him and we will all certainly miss him.
This untimely passing of a young colleague reminds us that as health care workers we must bear witness and become involved in sad events, sometimes involving protracted suffering over several years. While we also take comfort in the emotional highs that come from making positive changes for our patients, we must learn to shield ourselves from the lows by maintaining emotional distance and, understandably sometimes, a sense of denial.
But let's strive to rise above our vulnerability and denial. At the very least, let's drive a little more safely as we head home and then put aside our emotional distance and give our spouses and children an extra hug. Finally, we should appreciate how fragile our good health can be.
If
you have ideas or suggestions, please communicate them to me either in
person, by phone (650-725-0377) or e-mail larshuer@leland.stanford.
edu.
